Provider First Line Business Practice Location Address:
29 CALLE WASHINGTON
Provider Second Line Business Practice Location Address:
STE 508 ASHFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-729-0909
Provider Business Practice Location Address Fax Number:
787-729-0929
Provider Enumeration Date:
05/03/2006